Malvina Herceg

ICF Core Sets for depression.

OBJECTIVE To report on the results of the consensus process integrating evidence from preliminary studies to develop the first version of a Comprehensive ICF Core Set and a Brief ICF Core Set for depression. METHODS A formal decision-making and consensus process integrating evidence gathered from preliminary studies was followed. Preliminary studies included a Delphi exercise, a systematic review and an empirical data collection. After receiving training in the ICF and based on these preliminary studies, relevant ICF categories were identified in a formal consensus process by international experts from different backgrounds. RESULTS The preliminary studies identified a set of 323 ICF categories at the second, third and fourth ICF levels with 163 categories on body functions, 22 on body structures, 91 on activities and participation and 47 on environmental factors. Twenty experts attended the consensus conference on depression. Altogether 121 categories (89 second-level and 32 third-level categories) were included in the Comprehensive ICF Core Set with 45 categories from the component body functions, 48 from activities and participation and 28 from environmental factors. The Brief ICF Core Set included a total of 31 categories with 9 on body functions, 12 on activities and participation and 10 on environmental factors. CONCLUSION A formal consensus process integrating evidence and expert opinion based on the ICF framework and classification led to the definition of ICF Core Sets for depression. Both the Comprehensive ICF Core Set and the Brief ICF Core Set were defined.

Bionic reconstruction to restore hand function after brachial plexus injury: a case series of three patients

BACKGROUND Brachial plexus injuries can permanently impair hand function, yet present surgical reconstruction provides only poor results. Here, we present for the first time bionic reconstruction; a combined technique of selective nerve and muscle transfers, elective amputation, and prosthetic rehabilitation to regain hand function. METHODS Between April 2011, and May 2014, three patients with global brachial plexus injury including lower root avulsions underwent bionic reconstruction. Treatment occurred in two stages; first, to identify and create useful electromyographic signals for prosthetic control, and second, to amputate the hand and replace it with a mechatronic prosthesis. Before amputation, the patients had a specifically tailored rehabilitation programme to enhance electromyographic signals and cognitive control of the prosthesis. Final prosthetic fitting was applied as early as 6 weeks after amputation. FINDINGS Bionic reconstruction successfully enabled prosthetic hand use in all three patients. After 3 months, mean Action Research Arm Test score increased from 5·3 (SD 4·73) to 30·7 (14·0). Mean Southampton Hand Assessment Procedure score improved from 9·3 (SD 1·5) to 65·3 (SD 19·4). Mean Disabilities of Arm, Shoulder and Hand score improved from 46·5 (SD 18·7) to 11·7 (SD 8·42). INTERPRETATION For patients with global brachial plexus injury with lower root avulsions, who have no alternative treatment, bionic reconstruction offers a means to restore hand function. FUNDING Austrian Council for Research and Technology Development, Austrian Federal Ministry of Science, Research & Economy, and European Research Council Advanced Grant DEMOVE.

Electrotherapy for the treatment of painful diabetic peripheral neuropathy: a review.

OBJECTIVE To review different types of electrotherapy for the treatment of painful diabetic peripheral neuropathy. METHODS A structured search of the electronic database MEDLINE was performed from the time of its initiation to July 2009. Articles in English and German were selected. RESULTS The efficacy of different types of electrotherapy for painful diabetic peripheral neuropathy has been evaluated in 15 studies; the effects of transcutaneous electrical nerve stimulation are consistent. The beneficial effects of prolonged use have been reported in three large studies and one small study. The effects of frequency-modulated electromagnetic neural stimulation were assessed in one large study, and a significant reduction in pain was reported. Treatment with pulsed and static electromagnetic fields has been investigated in two small and three large studies, and analgesic benefits have been reported. In one large study focusing on pulsed electromagnetic fields, no beneficial effect on pain was registered. Only small studies were found concerning other types of electrotherapy, such as pulsed-dose electrical stimulation, high-frequency external muscle stimulation or high-tone external muscle stimulation. The conclusions drawn in these articles are diverse. Shortcomings and problems, including a poor study design, were observed in some. CONCLUSION Further randomized, double-blind, placebo-controlled studies comprising larger sample sizes, a longer duration of treatment, and longer follow-up assessments are required.

Do kinaesthetic tapes affect plantarflexor muscle performance

Abstract This study aimed to examine the effects of application of kinaesthetic tapes on plantarflexor muscle performance. We hypothesised that taping of the triceps surae muscle would improve plantarflexor muscle strength and endurance with no significant effect on drop jump performance. Using a repeated-measures design, all performance measures were obtained in 24 volunteers on two separate occasions: without tapes and after application of kinaesthetic tapes. Performance tests included measurements of isometric plantarflexor muscle strength and the associated electromyographic activity of the gastrocnemius muscle, an isokinetic fatigue resistance test (30 contractions at 180° · s−1) and assessments of drop jump performance. The taping-intervention was associated with an increase in gastrocnemius electromyographic activity. However, significant increases in isometric strength were only found at fully dorsiflexed ankle positions (+12% at −20°). Strength gains were negatively correlated to baseline strength (r = −.58). The intervention did not affect the results of the isokinetic fatigue and drop jump tests. The application of kinaesthetic tapes over the triceps surae muscle promotes an increase in isometric strength and gastrocnemius muscle activity. Our data suggest that these effects are joint-angle dependent and more prominent in weaker individuals. By contrast, the taping-intervention improves neither drop jump performance nor muscular endurance.

Functional electrical stimulation combined with botulinum toxin type A to improve hand function in children with spastic hemiparesis – a pilot study

ZusammenfassungHINTERGRUND: Kinder mit spastischer Hemiparese leiden häufig unter einer eingeschränkten Handfunktion. Gründe dafür sind Paresen, Spastizität sowie eine gestörte motorische Kontrolle. Ziel dieser Studie war die Effektivität der kombinierten Anwendung von funktioneller Elektrostimulation mit Botulinum Toxin A bei diesen Kindern zu untersuchen. DESIGN: Randomisiert, kontrolliert, Beobachter-geblindet, Pilotstudie. PATIENTEN: Kinder mit eingeschränkter Handfunktion aufgrund einer spastischen Hemiparese. INTERVENTIONEN: Die Einteilung erfolgte in zwei Gruppen: Die erste Gruppe erhielt eine kombinierte Behandlung von funktioneller Elektrostimulation mit Botulinum Toxin A, die zweite Gruppe wurde nur mit Botulinum Toxin A behandelt. Das Toxin wurde entsprechend der Klinik in die Armmuskulatur injiziert. Nach fünf bis sechs Tagen wurde mit der funktionellen Elektrostimulation der Hand- und Fingerextensoren begonnen. Die Behandlung erfolgte mittels Heimgerät zuhause und wurde zweimal täglich für 15 Minuten, über insgesamt drei Monate, appliziert. UNTERSUCHUNGSPARAMETER: Aktiver und passiver Bewegungsumfang, Muskeltonus, Muskelkraft und Funktionstests für Kinder. ERGEBNISSE: Sechs Kinder im Alter zwischen 7 und 17 Jahren mit spastischer Hemiparese wurden in die Studie eingeschlossen. In beiden Gruppen verbesserten sich der aktive und passive Bewegungsumfang, der Muskeltonus und die Muskelkraft nach 3 und 6 Monaten im Vergleich zur Ausgangsuntersuchung. Eine Verbesserung bei den Funktionstests zeigte sich nur in der Gruppe mit der kombinierten Behandlung. DISKUSSION: Die Kombination von funktioneller Elektrostimulation mit Botulinum Toxin A ist eine vielversprechende Therapieoption zur Verbesserung der Handfunktion bei Kindern mit spastischer Hemiparese.SummaryBACKGROUND: Children with spastic hemiparesis frequently present with impaired hand function due to paresis, spasticity, and disturbed motor control. The aim of this study was to examine the effectiveness of functional electrical stimulation in combination with botulinum toxin type A in these children. DESIGN: Randomized, controlled, observer-blinded pilot study. SUBJECTS: Children with impaired hand function. INTERVENTIONS: Either a combined treatment group (functional electrical stimulation and botulinum toxin type A) or a botulinum toxin type A group alone. Botulinum toxin type A was injected into arm muscles according to the patients clinical requirements. Functional electrical stimulation of the wrist and finger extensor muscles was started after five to six days. Patients were given a stimulation device and asked to use it at home twice daily for 15 min, for a total period of three months. MAIN MEASURES: Active and passive range of motion, muscle tone, muscle strength, and functional tests for children. RESULTS: Six children aged between 7 and 17 years with spastic hemiparesis were enrolled. In both groups, active and passive range of motion, muscle tone, and muscle strength improved after three and six months compared to baseline data. The functional score was improved only in the group that received combined treatment. CONCLUSIONS: Combined treatment with functional electrical stimulation and botulinum toxin type A is a promising treatment option to improve upper limb function in children with spastic hemiparesis.

Prosthetic reconstruction in high amputations of the upper extremity

ZusammenfassungHintergrundDie Steuerung myoelektrischer Armprothesen erfolgte konventionellerweise über zwei Oberflächenelektroden, welche von zwei getrennt innervierten Muskelgruppen angesteuert werden. Zwischen den verschiedenen prothetischen Gelenken wird mittels Kokontraktion dieser Muskeln gewechselt und in der jeweiligen Ebene mit denselben Muskeln linear gesteuert. Ein harmonischer, dem natürlichen Bewegungsmuster entsprechender Bewegungsablauf ist mit diesem Steuerungsmechanismus nicht möglich.FragestellungÜbersicht über die chirurgischen, therapeutischen und prothetischen Möglichkeiten bei hohen Amputationen der oberen Extremität.Material und MethodeEs erfolgte eine selektive Literaturrecherche unter Berücksichtigung eigener Erfahrungen des klinischen Alltags und Durchsicht von Patientenakten.ErgebnisseDurch selektive Nerventransfers der amputierten Armnerven des Plexus brachialis auf verbliebene Stumpfmuskulatur können bis zu sechs Signalgeber geschaffen werden, welche intuitiv und simultan die verschiedenen prothetischen Gelenke steuern können. Auf diese Weise ist eine effiziente und harmonische Steuerung der Prothese gewährleistet ohne dass der Patient zwischen den verschiedenen Steuerungsebenen wechseln muss. Gleichzeitig werden etwaige Neurome behandelt und somit ein schmerzfreies Tragen der Prothese ermöglicht. Aufgrund der dadurch vermehrten Verwendung von myoelektrischen Prothesen steigen auch die Anforderungen an den Stumpf. Hier gilt es sowohl chirurgisch als auch orthopädietechnisch eine stabile Verbindung zwischen Stumpf und Prothese zu schaffen, um eine optimale Prothesenfunktion zu ermöglichen.AbstractBackgroundConventional upper arm prostheses are controlled via two surface electrodes that measure motor activity of two separately innervated muscle groups. The various prosthetic joints are chosen by co-contractions and controlled linearly by these two muscles. A harmonious and natural course of movements is not possible in this way.ObjectivesOverview regarding surgical, therapeutical and prosthetic options in high amputations of the upper extremity.MethodsSelective literature research including the authors’ own experience in everyday clinical practice as well as a review of medical records.ResultsSelective nerve transfers of the amputated nerves of the brachial plexus to the remaining stump muscles can create up to six myosignals for intuitive and simultaneous control of the different prosthetic joints. In this way, an efficient and harmonious control of the prosthetic device is possible without the need to change between the different control levels. At the same time, possible neuromas are treated and painless wear of the prosthesis is achieved. Due to the resulting extended use of the prosthetic device, the demands regarding stump quality are increased. Thus, both surgically and by the means of the orthopedic technician a stable stump-socket connection should be achieved to enable optimal prosthetic function.

Advanced Rehabilitation for Amputees after Selective Nerve Transfers: EMG-Guided Training and Testing

A special kind of selective nerve transfer, targeted muscle reinnervation, can provide upper limb amputees with up to 6 intuitive myosignals to govern their myoelectric prosthesis. Following surgery, a comprehensive rehabilitation package is required. It should include electromyographic (EMG) feedback training to facilitate recruitment of newly reinnervated muscles. In order to select appropriate tasks for training, an EMG testing tool is required that can provide clinicians with scores directly reflecting the patient’s ability to generate myoelectric signals. Here, an EMG testing tool implementing the Item Response Theory for ability classification is presented. Used for testing healthy subjects and patients, the tool was able to detect an increase of muscular coordination with training, as well as existing deficits in motor control. These findings suggest that this tool can assist in rehabilitation planning for patients after selective nerve transfers.

Elective amputation and bionic substitution restore functional hand use after critical soft tissue injuries.

Critical soft tissue injuries may lead to a non-functional and insensate limb. In these cases standard reconstructive techniques will not suffice to provide a useful outcome, and solutions outside the biological arena must be considered and offered to these patients. We propose a concept which, after all reconstructive options have been exhausted, involves an elective amputation along with a bionic substitution, implementing an actuated prosthetic hand via a structured tech-neuro-rehabilitation program. Here, three patients are presented in whom this concept has been successfully applied after mutilating hand injuries. Clinical tests conducted before, during and after the procedure, evaluating both functional and psychometric parameters, document the benefits of this approach. Additionally, in one of the patients, we show the possibility of implementing a highly functional and natural control of an advanced prosthesis providing both proportional and simultaneous movements of the wrist and hand for completing tasks of daily living with substantially less compensatory movements compared to the traditional systems. It is concluded that the proposed procedure is a viable solution for re-gaining highly functional hand use following critical soft tissue injuries when existing surgical measures fail. Our results are clinically applicable and can be extended to institutions with similar resources.

A surface EMG test tool to measure proportional prosthetic control.

Abstract In upper limb amputees, prosthetic control training is recommended before and after fitting. During rehabilitation, the focus is on selective proportional control signals. For functional monitoring, many different tests are available. None can be used in the early phase of training. However, an early assessment is needed to judge if a patient has the potential to control a certain prosthetic set-up. This early analysis will determine if further training is needed or if other strategies would be more appropriate. Presented here is a tool that is capable of predicting achievable function in voluntary EMG control. This tool is applicable to individual muscle groups to support preparation of training and fitting. In four of five patients, the sEMG test tool accurately predicted the suitability for further myoelectric training based on SHAP outcome measures. (P1: “Poor” function in the sEMG test tool corresponded to 54/100 in the SHAP test; P2: Good: 85; P3: Good: 81; P4: Average: 78). One patient scored well during sEMG testing, but was unmotivated during SHAP testing. (Good: 50) Therefore, the surface EMG test tool may predict achievable control skills to a high extent, validated with the SHAP, but requires further clinical testing to validate this technique.

Correlation of functional recovery with the course of electrophysiological parameters after free muscle transfer for reconstruction of the smile in irreversible facial palsy.

Introduction: The aim of this study was to determine whether processes of denervation and reinnervation, as measured by electrodiagnostic methods, correlate with clinical function, as measured by three‐dimensional (3D) video analysis and whether electrodiagnostic data can serve as a prognostic indicator. Methods: Eighteen patients with facial palsy were investigated by 3D video analysis, needle electromyography, and electrical muscle testing at 6, 12, and 18 months after free muscle transplantation for smile reconstruction. Results: Electrophysiological parameters determined 6 months postoperatively correlated significantly with the index of dynamic symmetry 12 and 18 months postoperatively. Conclusions: Processes of reinnervation can be detected earlier by electrophysiological analysis than by quantified clinical analysis. Pathological spontaneous activity alone and combined assessment with motor unit action potentials in the early postoperative stage are strong prognostic indicators. Muscle Nerve, 2011